Asthma management in accident and emergency and the BTS guidelines - A study of the impact of clinical audit

Objective-To determine whether the care of asthma patients in accident and emergency Departments (A&E) is improved by clinical audit of asthma management. Methods-The quality of care during continuous cycles of clinical audit was compared with that one year later, after an audit programme had ended and most of the medical staff had changed. This was done by a retrospective case notes review of all asthma cases (n = 79) in April and May 1993, compared to the same months (n = 93) in 1994. Results-The quality of care was higher during the audit in a number of areas, as determined by conformity to the British Thoracic Society (BTS) guidelines. Comparing the management of episodes for the earlier to the later study periods, the significant differences were: the ability to complete a sentence in one breath was recorded in 63% and 33% of episodes; a nebuliser was given when indicated in 97% and 88%; when indicated a chest x ray was ordered in 73% and 43%; and arterial blood gases were measured in 73% and 33% of episodes. Conclusions-The initial assessment and management of asthma was better when the audit was in progress. However, in both study periods some areas of care did not receive the attention recommended in the BTS guidelines, these were all areas which would have influenced asthma control after discharge.